MGMA 10/13/15

My third and final day at MGMA got started bright and early with a session led by Aledade CEO Farzad Mostashari, MD on the ways in which independent practices can thrive in an era of risk-based contracting. Dixieland jazz and clogging were not part of his presentation, though he did take the still-sleepy audience through his very own “I Decide to Cha Cha” mnemonic:

I = Incentives. Mostashari explained that independent practices need to align incentives with the outcomes they want to achieve.
D = Decision. Going the risk-based route takes courage, and once that decision is made there’s no going back successfully. I thought his observation,“People don’t hate change; they hate being changed,” was spot on given a previous day’s speaker’s belief that doctors are called doctors because they’ve been “indoctrinated” to hate change and love the status quo. 
T = Teams. Mostashari stressed the need for independent MDs to partnering with other organizations when moving to value-based payment models. “Just because you’re independent doesn’t mean you have to go it alone,” he added. Abiding by Amazon’s two-pizza rule is a good place to start when contemplating collaboration.
C = Change. Pull the trigger on those new partnerships and contracts, and commence transitioning.
A = Assess. All the change in the world won’t do you much good if your practice isn’t learning along the way.

Mostashari ended his dancing analogy by stressing a second “cha” – taking another look at ways the practice still might need to change and assess. I had the opportunity to chat afterwards with several folks from Aledade client Arkansas Foundation for Medical Care, a nonprofit that assists physicians with practice transformation. I pumped them for information related to the pain points their practices have experienced over the last year or two, learning that their clients have shown a lot of interest in figuring out how to engage patients in the use of healthcare IT tools, not to mention taking ownership of their own health. A lack of consistency around quality measures has also been a problem area for the Arkansas-based organizations. The entire AFMC team agreed that there needs to be standardization around quality measures, a problem they told me is exacerbated by the fact that EHRs are neither equipped or required to report on all of them.

I headed to the next session by way of a very popular and presumably comfy stairwell. I suppose this sort of thing is par for the course when you pull busy practice managers away from their daily routines. I’m sure I wasn’t the only one who was thankful for the speedy and reliable WiFi throughout the conference center.

I was happy that MGMA attendees were not shy about letting me share their well-shod feet with HIStalk Practice readers. I don’t think I’ve ever seen so many pairs of cowboy boots in my life. After my quick fashion digression, I headed to a session focused on creating high-performing medical groups, which was somewhat underwhelming when compared with the previous one. Where Mostashari had emphasized doing good for the good of the patient, representatives from Sutter Health and The Camden Group seemed totally focused on keeping physicians happy. An understandable consideration given the setting, but I was still surprised that the role of patient as a vital partner in creating that high performance was never brought up.

I sat next to Teri Paluso, administrator at ambulatory surgery center IPC Surgical in Louiston, ID. Paluso is living in an interesting world right now. Her practice is in the process of being acquired by the local hospital due in large part to the desire of the practice’s three physicians to retire within the next several years. IPC is literally picking up shop and moving to a new location as a result of the acquisition. Practice staff aren’t looking forward to jumping from their CompuGroup Medical system to the hospital’s new “latest and greatest” version of Meditech, which Paluso tells me by all accounts is very buggy. She confessed that she wonders if she’ll become part of the 30 percent of practice administrators that typically quits after a hospital acquisition.

After another quick lunch in the exhibit hall, I walked the show floor one last time, where I ran into folks from patient messaging vendor Dialog Health, CoverMyMeds, and Influence Health. I also got the chance to catch up with American Well Sales Executive Whitney Jordan, who took me through a tour of the company’s consumer app. To my knowledge, American Well was the only telemedicine vendor on the show floor – a smart move on the company’s part given several MGMA speakers’ observations that practices need to get ready to compete with up-and-coming business models like telemedicine and house calls.

My last stop in the exhibit hall was at the Skywriter MD booth, where President and CEO Tracy Rue walked me through the genesis of the Colorado-based startup, which has developed a real-time EHR documentation tool that incorporates remote scribes. Rue emphasized that while in-office scribes can slow down productivity, virtual scribes working in real time alongside the physician keeps the vital human element of coding intact.

My last stop of the day was into a session led by Marni Jameson, a former journalist, PR agency owner, and hospital marketer who now serves as executive director for the Association of Independent Doctors. Passions ran high as she recounted the ways in which a lack of independence hurts the local economy, physician employment prospects, and care quality. Her action items were fairly media heavy. I don’t see how a practice can effectively ward off a hospital acquisition by simply creating literature that explains to patients why it’s important not to cheat with hospital-employed MDs. While I found some of her pointers to be fairly pie-in-the-sky, the audience gobbled it up, even cheering at one point when Jameson sarcastically pointed out the “benefits” nonprofit hospitals bring to communities. 

My biggest takeaways from the conference include:

• ICD-10 is soooo September 30. Everyone seems to be moving on to more pressing issues and/or getting back to business as usual.
• Patient access (getting into urgent care, competing with/adopting telemedicine, etc.) seems to have replaced patient engagement on physician to-do lists.
• Collaboration is key, especially when moving from fee-for-service to value-based care.
• Chronic-care management is fun to talk about, but at this point challenging to understand and implement. Early adopters will find themselves popular speakers at next year’s event if they’re willing to share best practices.

I’d love to learn what other attendees thought of the show. Feel free to leave your observations in the comments below. We can compare retrospective notes at next year’s event in San Francisco.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 10/13/15

Top News

Republican presidential candidate Jeb Bush pushes for innovation in his healthcare plan, released on the eve of the first Democratic debate. The high-level outline to repeal the ACA does have a health IT angle, calling for private-sector leadership of healthcare IT adoption and better access to de-identified Medicare and Medicaid patient claims data. “Proven data analytics” also shows up in his call to personalize care solutions for high-risk individuals.

#HIStalking Tweet Chat – Patient Engagement Outside the Office

Loran Cook (@loranstefani) will host the next #HIStalking tweet chat on Thursday, October 15 at 1pm ET. Check out discussion topics here.

Acquisitions, Funding, Business, and Stock

Xerox takes a $240 million loss in Q3 as a result of its decision not to finish up installation of Medicaid management IT systems in California and Montana. The company, which won a $565 million contract in April to handle Medicaid processing for the state of New York, attributes the decision to a change in strategy that it hopes will improve financial performance and reduce uncertainty in quarterly earnings.

Announcements and Implementations

Heart and Vascular Center of Lake County (IL) implements the Allscripts CCM program to help improve care for those patients who need temporary nursing home care.

Riverside Medical Associates (MI) receives its first reimbursement from ICD-10-coded claims using iPatientCare’s EHR and PM system.

Government and Politics

AAFP makes no bones about its lack of enthusiasm for ONC’s final interoperability roadmap. “We need more than a roadmap; we need action,” writes Board Chair Robert Wergin, MD in a letter to National Coordinator Karen DeSalvo, MD. “First, it is our belief that without significant changes in the way healthcare delivery is valued (e.g. paid) then it will not matter how many standards are created, how many implementation guides are written, how many controlled vocabularies are fortified, or how many reports are created; we will still struggle to achieve interoperability. Any roadmap for interoperability needs to ensure payment reform toward value based payment, in addition to the technical work.”

Research and Innovation

A cyber security survey of 398 healthcare professionals finds that an average of 78 percent are concerned most about losing patient data, as opposed to IP and financial data, in the event of a breach. Despite the high level of concern, 35 percent of technical respondents say their organization doesn’t have enough staff and security expertise to handle security – a statistic that unfortunately meshes well with the 34 percent of technical respondents who note their businesses perform vulnerability testing just once a year.

A survey of 300 PCPs finds that 70 percent of physicians say they don’t fully understand the relatively new CMS chronic care management billing code, and only 20 percent use it – statistics shored up by my conversations with MGMA attendees and exhibitors. One knowledgeable vendor explained that only the very early adopters are working with the code now, while everyone else is taking a wait-and-see approach before diving into uncharted waters.

A seven month-long Penn Medicine study of 1,000 ED patients finds a strong correlation between their social media posts and health, leading researchers to build a language databank in order to further explore the idea of tying social media content to health outcomes. “Finding ways to effectively harness and mine [this] data could prove to be a valuable source of information about how and why patients communicate about their health,” says Raina M. Merchant, MD the study’s senior author. “There is a rich potential to identify health trends both in the general public and at the individual level, create education campaigns and interventions, and much more. One of the unique aspects of this data is the ability to link social media data with validated information from a health record.”

Telemedicine

Pittsburgh’s local NPR station profiles Matthew Keener, MD and the telepsychiatry company he founded specifically to serve young adults with mental health issues. Keener spent about a year at Doctor on Demand before launching Blackbird Health in April. He seems to have an amicable working relationship with his former employer, given that the Blackbird Health website directs visitors to DoctoronDemand.com for 24/7 assistance.

Other

ACP outlines its views on the role of retail health clinics in a new policy position paper, stressing that they should be a backup rather than a relied-upon alternative to primary care visits. Among its six directives is the belief that retail clinics should take responsibility for communicating health data to a patient’s PCP, and that patients should initiate conversations with retail clinic physicians about what that data should be.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 10/12/15

Top News

Singapore-based analytics and consulting firm AntWorks acquires Lynchburg, VA-based medical billing and PM vendor Benchmark Systems for an undisclosed sum. Benchmark Systems will continue to operate as a standalone brand, providing AntWorks with a solid entry into the ambulatory market.

HIStalk Practice Announcements and Requests

Couldn’t make it to Nashville for this year’s MGMA? Check out the highlights via my recaps from Sunday and Monday. I’ve learned thus far that you can integrate Dixieland jazz and clogging into conversations about ICD-10, collaboration, and chronic care management.

#HIStalking Tweet Chat – Patient Engagement Outside the Office

Loran Cook (@loranstefani) will host the next #HIStalking tweet chat on Thursday, October 15 at 1pm ET. Check out discussion topics here.

Announcements and Implementations

Culbert Healthcare Solutions partners with ConnexaHealth to offer its IT optimization and consulting services.

AdvancedMD launches performance benchmarking and interoperability tools.

Telemedicine

CareFirst BlueCross BlueShield issues RFPs for nonprofits or government organizations seeking funding for telemedicine programs that will improve access and increase efficiency. The payer will award up to $3 million over the next three years to selected programs in its service territory of Maryland, Northern Virginia, and Washington, DC. RFPs are due November 23.

AMA’s new Telehealth Services Group meets to begin looking at proposals that will expand CPT’s current telehealth codes to include emerging services. "Input from the Telehealth Services Workgroup will help the CPT code set reflect new technological and telehealth advancements available to mainstream clinical practice,” says AMA President Steven J. Stack, M.D, adding that it will ensure the code set can “fulfill its role as the health system’s common language for reporting contemporary medical procedures.”

A group of legislators led by Senators Joni Ernst (R-IA) and Mazie Hirono (D-HI) introduce the Veterans E-Health & Telemedicine Support Act in an effort to expand the number of eligible sites veterans can receive treatment via telemedicine.

Government and Politics

CMS develops a privacy management tool consumers can use while shopping on Healthcare.gov to opt out of sharing data with the third-party vendors that analyze the health insurance exchange’s performance.

Research and Innovation

AMA and MGMA announce the top five proposals submitted for their joint Practice Innovation Challenge, which seeks to recognize “innovative strategies that will help physicians and their staff thrive in the new healthcare environment.” The sponsoring organizations – Asante Physician Partners (OR), Center for Excellence in Primary Care at the University of California, San Francisco, Stanford University (CA), University of Tennessee Health Science Center, and Vanguard Medical Group (NJ) – will receive a $10,000 prize and the opportunity to co-develop with AMA and MGMA an educational module that can be shared with practices across the country.

Other

Cost-conscious physicians may want to consider following the example of Northwest Georgia Medical Clinic, which, aided by the assistance of generous tax credits, installed rooftop solar energy panels to offset over 50 percent of its energy consumption. The panel system’s accompanying app also shows that the clinic has saved nearly 119,000 pounds of carbon dioxide emissions since it was installed, akin to planting more than 6,600 trees.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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MGMA 10/12/15

There’s nothing like live clogging at eight in the morning to really get the day started. My second day at MGMA do-si-doed/kicked off with morning presentations to a packed house. One attendee grumpily tweeted about the lack of seating in light of the amount of money she spent on attendance – a valid point, though I did notice at least two dozen empty seats scattered throughout the ballroom.

The keynote kicked off in a similar fashion as yesterday’s – a quick run through of MGMA honors, including presentation of the MGMA/AMA Practice Innovation Award winners and MGMA Lifetime Achievement Award winner Alan Beason, CEO, Cardiovascular Consultants, followed by featured speaker Atul Gawande, MD.

Gawande strikes me as healthcare’s consummate Renaissance man; his talents seem far and wide, reaching beyond medical practice to writing and even movie-making. Gawande’s presentation, “From Cowboys to Pit Crews,” stressed the need for physicians to stop practicing like the Lone Ranger and start thinking more collaboratively. He told several compelling patient stories, each highlighting gaps in care that resulted from lack of communication and resulted in avoidable pain and suffering. He stressed that it wasn’t the patient’s pain that bothered him most about these stories – it was the fact that the care teams didn’t learn from their mistakes. Each adverse event stayed in its silo, never to be shared with colleagues down the street so that they could learn from literally septic errors.

Gawande drove his point home by recounting a World Health Organization-sponsored palliative care project that has seen more positive outcomes through the use of advanced care planning modules. By simply asking patients about their end-of-life goals and including that information in the patient’s EHR, each member of the patient’s care team became aware of what treatments were necessary and unnecessary. Quality of life, and even life expectancy, improved for project patients, prompting Gawande and his fellow clinicians to imagine the outcome possibilities if all patients – no matter their condition -  were treated in this manner. Collaboration was quickly shaping up to be the buzzword of the day.

After the keynote, I headed to the exhibit hall to peruse the booths more thoroughly than the night before. I couldn’t resist snapping this pic of Denise Ray and “Lance” from Technology Express. Talk about a clever way to exhibit without paying for a booth. They hung outside of the exhibit hall for most of the afternoon, engaging passers by in conversation about how their virtualization technology can be used in clinical practice training.

The CareSync booth was buzzing, no doubt due in part to the company’s recent Series B round of $18 million. Marketing Coordinator Shannon McNamara was kind enough to run through a quick demo of the company’s PHR with me. The intuitive interface included patient-entered goals and health and wellness notes, just as Gawande had advocated for earlier. Score one more for collaboration.

I spent a few minutes chatting with Greenlight sales rep Pablo Mendoza, who explained that the three year-old company has developed the industry’s only digital psychological evaluation assessment tool, one that has already gained the endorsement of the Texas Medical Association. Mendoza and his show-floor colleague were positively giddy that no other MGMA exhibitors were demonstrating anything remotely related to mental health, which makes me wonder why this facet of healthcare is so underrepresented here in Nashville.

After my morning tour of the show floor, I headed to the session on “Your Declaration of Independence – Creating an Infrastructure for Population Health,” where I spent a few minutes beforehand chatting with Bill Johnson, executive director of Fort Worth, TX-based JPS Physician Group. Johnson had a keen interest in the topic due to his group’s growing emphasis value-based business models, and their coinciding desire to get the most out of their Epic system, which he told me is not being used to its fullest capability. Johnson and his executive team will also have their hands full preparing the group’s physicians to become employees of JPS Hospital. Needless to say, he seemed to have a lot on his plate. 

InHealth SVP of Clinical Services Gerard Filicko tweeted out this picture of the session’s attendees, who had a ton of questions around strategy and action items for Filicko and co-presenter Stephen Cavalieri, MD CMO of the Central Virginia Health Network. Most concurrent sessions seemed to be just as packed, if not more so. There was a line out the door and down the hallway for the session immediately afterwards, “30 Cost-Saving Ideas for Your Medical Practice,” which no doubt could have been a conference in and of itself.

Lunchtime saw attendees being herded into what felt like a massive underground bunker for a catered buffet courtesy of Ingenious Med. The food was actually quite good; the conversation was even better. I had the good fortune to sit with Everton Prospere, MD and his colleagues from SUNY Downstate Medical Center in Brooklyn, NY. While his peers chatted about the need to look around for electronic billing solutions, Prospere obliged me by sharing his view of ICD-10. “That is painful,” he opined. “Who does it ultimately benefit? Will it improve patient care, or give payers an excuse to deny claims?”

Prospere’s ICD-10 frustrations were not reflected in the ICD-10 Town Hall payer session I crashed after lunch. Representatives from Humana, UnitedHealthcare, and Emdeon calmly recited statistics around the non-event that ICD-10 has thus far been. Everyone seems to be cautiously optimistic, but fully prepared for the other shoe to drop when denied claims start rolling in this week or next.

The VisiQuate booth caught my attention during my second lap around the exhibit hall, thanks in large part to the fantastic shoes sported by its sales reps. The gentlemen explained that VisiQuate’s physician group analytics dashboard also seemed to be pulling people in an observation that jived with Cavalieri’s earlier comment on the need for physician benchmarking. Physicians are inherently scanners, he explained, and need report cards to prompt them to improve and/or compete with their colleagues down the street.

Athenahealth Senior Product Marketing Associate Shivani Mishra gave me a tour of the company’s ICD-10 Nerve Center, which has been keeping track of the cleanliness of customer claims coded in 10 since the October 1 transition. Athenahealth’s numbers reinforced the notion that it’s business as usual, at least for right now.

Clinispectrum’s always smiling CEO Vishal Gandhi spared a few minutes to catch me up on the company’s renewed focus on digital patient engagement and education materials. Its highly visual (and highly affordable, from what he tells me) library of content has garnered interest from the likes of Medfusion, which will likely look at integrating them into its practice portal.

The ladies at Learning Harbor, a company that provides Web-based regulatory compliance training for healthcare employees, were an absolute delight to talk to. They reeled me in with a pastry brush, and then kept me chatting about the morning’s keynote and the need for increased attention to palliative care processes. Both nurses, they seemed all too familiar with the lack of patient-centeredness in healthcare delivery.

It was great to see sponsor Versus Technology proudly display their HIStalk sign as I left the exhibit hall for the evening.

I ended the day at Stericycle’s party, which had a great turnout at the Gaylord’s Fuse sports bar. Company staff seemed to be having a great time taking pictures with customers in giant green cowboy hats and matching bandanas. Perhaps HIStalkapalooza should have a “Best Hat” category next year. Until tomorrow …

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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MGMA 10/11/15

Aside from very finicky WiFi at the hotel, my first day at my second MGMA conference was smooth sailing. The trip to Nashville has been so much more pleasant than my trek to Las Vegas for last year’s event. The three-and-a-half hour car ride through Tennessee mountains and valleys under sunny skies put me in a great mood by the time I arrived at the Gaylord Opryland Hotel & Convention Center. The soothing sounds of waterfalls, beautiful blown-glass sculptures, shopping, and helpful MGMA volunteers also kept my spirits up. The MGMA15 app also seemed to keep attendee morale high, given the complimentary tweets it garnered.

After grabbing my press badge, I headed to the opening keynote, where I ran into Jamie Simonds and Pamela Kershes, both office managers for independent Capital Area Pediatrics (VA). They are new MGMA members, eager to explore all that the conference has to offer. It didn’t take us long to get talking about ICD-10, which both women assured me went smoothly at the six-practice organization, a GE Centricity shop – a sentiment I heard throughout my first few hours at the conference.  I later spied the two checking out RCM solutions at the RemitData booth.

A Dixieland jazz band greeted attendees as we filed into the keynote ballroom. The space has nothing on the likes of HIMSS. It felt downright small by comparison, which made the antics of the band members all the more enjoyable as we waited for the presentation to commence.

After the typical organizational pleasantries – presentation of the Board of Directors, thank yous to all involved, etc., MGMA President and CEO Halee Fischer-Wright, MD took the stage and got straight to business: Physicians are really good at complaining, she noted, but not so great at channeling their frustrations into change. She even engaged in a little pillow talk, divulging the documentation complaints of her physician husband, who now believes MD stands for “Miserable Doctor.”

Her presentation can be boiled down to four words: “Stop Whining. Start Leading.” She called for a revolution in practice management, telling physicians the time has come to embrace their inner MBA rather than continue to stick their heads in the sands of financial ignorance and mismanagement. She had nothing kind to say about Meaningful Use or EHRs, a sentiment cheered by attendees, who also applauded her frankness on the subject of incentive programs that ultimately get in the way of patient care.

Fischer-Wright also made sure to emphasize the need to level the playing field between payers and practices, telling the crowd that, “It’s time we get as good at fighting for our dollars as insurance companies have gotten at fighting for theirs.” I could have sworn she mentioned United Healthcare in this context, which is fairly ironic given that they’re exhibiting this year.

After a fairly underwhelming keynote from Jeremy Gutsche, author and founder of TrendHunter.com, I headed to the opening reception in the exhibit hall, an area that wasn’t hard to cover given that it seemed significantly smaller than last year’s layout. There also seemed to be a general downsizing on the part of all exhibitors – no two-story booths, adjacent closet-like conference rooms or in-booth presentation areas. The largest real estate seemed to be taken up by Athenahealth, which was well warranted given the amount of foot traffic they had in just the first two hours.

I couldn’t resist snapping this pic of the Healthicity booth, which also seemed to be consistently busy. The company is new to me: The T-shirt shaped flyer included with my press credentials tells me it focuses on auditing, compliance, and analytics solutions.

I’m typically a sucker for a good caricature, but Experian’s chairs were all taken by attendees either sitting for portraits or demos.

Optum’s pink punching bags pulled me in. They plan on donating up to $2,500 to the Breast Cancer Research Foundation provided they get enough signatures on the bags. Like many others, it didn’t take me long to come up with the names of people in my life that have been affected by breast cancer.

A quick note-taking break gave me the opportunity to chat with Michelle DePew and Carol Hamerski from the Kemper CPA Group, who also didn’t have any practice-shattering news to share about ICD-10. DePew told me she got the most physician calls two days before October 1. Their clients work with a variety of EHRs and PM solutions including EClinicalWorks and Epic.

AdvancedMD’s new booth and branding caught my eye. They have not hesitated to move forward with forging their own identity after splitting from ADP.

Companies willing to do good and give back also tend to reel me in, and Dispensary of Hope was no exception. The charitable medication distributor connects surplus medications from providers, distributors, and manufacturers to a network of safety net clinics serving the poor and uninsured.

Speaking of no exceptions, whack-a-mole always seems to draw a crowd. (There was a line four deep at the ScribeAmerica booth.) I still don’t understand the fascination. I may have to circle back tomorrow to see what they are giving away.

The UnitedHealthcare booth was hopping, perhaps because of Fischer-Wright’s keynote mention. She also mentioned that collaboration will be key to physicians taking back their “power,” and United has definitely become adept at forging new partnerships.

Miniature golf is also one of those show-floor activities that never seems to disappoint. The Avery Partners team seemed to be having a good time.

My second-to-last last photo op came at the end of the opening reception, courtesy of the friendly ladies of Tennessee MGMA. Emily McClure, practice manager of two facilities within the Knoxville, TN-based University Pulmonary and Critical Care network, told me that MGMA offers her the perfect opportunity to shop around – not necessarily for a specific technology or solution, but for industry developments she needs to stay on top of.

I couldn’t leave the exhibit hall without snapping some fashionable footwear, and what’s a trip to Nashville without cowboy boots? The folks at Pulse Systems didn’t hesitate to put their best feet forward, after which I headed to the hotel for dinner and the day’s recap. Until tomorrow …

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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